Guest Editorial: The Pressure for Global Collaboration

Despite an increasing number of products devoted to pressure ulcer treatment and prevention, pressure ulcers continue to be a healthcare problem throughout the world. The prevalence of pressure ulcers has remained approximately 15% in healthcare facilities in the US between 1999 and 2005.¹ In Canada, the prevalence has been reported to be 26%² and the European Pressure Ulcer Advisory Panel (EPUAP) found an overall prevalence of 18.1% in a survey of patients in Belgium, Italy, Portugal, Sweden, and the UK.³ It is obvious that pressure ulcers are an international problem.  

   The reduced quality of life for patients and increased morbidity and mortality, as well as the changing economic picture, require us all to focus our collective resources. The National Pressure Ulcer Advisory Panel (NPUAP) recently completed an ambitious 4.5-year project in collaboration with the EPUAP that resulted in the development of the NPUAP and the EPUAP 2009 International Pressure Ulcer Prevention and Treatment Clinical Practice Guideline and Quick Reference Guide. Sixty-three countries and six continents were represented by individuals and organizations registered as stakeholders. The energy and commitment of these individuals are evident in the finished product.

     There is both a synergy and magnification of resources in an international collaboration. Although the Internet has made the world more accessible, the act of collaborating and working together allows for even better outcomes. My work as the co-chair of the Shear Force Initiative increased my belief that only through collaboration will our field progress at the rate necessary. The opportunity for members of the NPUAP, EPUAP, Japanese Society of Pressure Ulcers (JSPU), clinicians, researchers, and industry members from around the world to meet and focus on the issue of shear in the development of pressure ulcers encouraged new innovative research and created new relationships and collaborations that will produce a ripple effect in other areas of pressure ulcer research, prevention, and treatment.

     Collaborating with and learning from our peers worldwide are invaluable and essential to the advancement of our field. In this spirit, on February 25 the NPUAP is hosting the International Multidisciplinary Consensus Panel on the Issues of Avoidable and Unavoidable Pressure Ulcers in All Care Settings at Johns Hopkins University, Baltimore, MD, sponsored through an unrestricted educational grant from Hill-Rom (Batesville, IN). We have invited colleagues from around the world to participate in this critical discussion. In the US, as of October 1, 2008 the Center for Medicare and Medicaid Services (CMS) will no longer reimburse acute care facilities for hospital-acquired Stage III or Stage IV pressure ulcers (termed never events) at a higher diagnosis-related group when billed as a secondary diagnosis. But are all pressure ulcers avoidable? Is there ever a time when we might sacrifice the skin in order to save a life — is this ever acceptable? Do the criteria for avoidable and unavoidable pressure ulcers vary by patient population or care setting? Is the development of a pressure ulcer an indicator of skin failure at life’s end or is it the indicator of our failure to prevent skin breakdown?

     I invite you to join us at the global table at this exciting time in our field to take part in the consensus panel conference to discuss this important topic. Together, I believe we can again move that cutting edge of our field forward for the benefit of our patients.

This article was not subject to the Ostomy Wound Management peer-review process.

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